15 years ago, photographing the sole of a diabetic foot at home sounded almost whimsical.
Today, a fascinating new paper asks us to take one more step: what if the camera lived in the bathroom scale?
The sole specifically and the foot in general is an awkward place to inspect. Neuropathy can remove pain as an alarm, while limited vision, flexibility, or mobility can make a daily self-examination difficult. Yet this is precisely where important pre-ulcerative changes and wounds may appear. A useful home system must therefore do more than make a good image. It must make repeated imaging easy enough to survive ordinary life.
Hu and colleagues evaluated the Empo Footprint, an internet-connected home scale that captures high-resolution, full-color images of the plantar feet during ordinary use. The patient does not have to bend down, recruit a family member, or find the perfect camera angle. They simply step onto the scale.
In this retrospective formative evaluation, 21 people with a history of diabetic foot ulceration were followed using seven months of existing program data. The device was used on 82.5% of possible days. Podiatrists reviewed 3,295 scans, and 97.7% were considered usable for clinical assessment. Longitudinal images showed concerns including a foreign body, new ulceration, and early skin breakdown.
Those numbers are encouraging. They are not, however, evidence that the device reduces ulcers, hospitalizations, or amputations. This was a small feasibility study, not an outcomes trial. The next step is prospective testing of what happens after the image becomes an alert and the alert becomes care.
A family tree, not a first step
The imaging scale did not spring fully formed from the bathroom floor. In 2010, Bus and colleagues evaluated a dedicated home device for standardized color photography of the plantar foot. In 2017, Professor Moi Hoon Yap and colleagues introduced FootSnap, an app designed to make repeat diabetic-foot photographs more consistent.
In parallel, our own Foot Selfie work asked whether people with diabetes could use ordinary phones to send clinically useful images from home. The answer was yes—although assistive devices or another person often improved image quality. A later dedicated home system folded those images into regular remote review.
COVID accelerated the road; it did not build it
The chronology matters. Manchester’s work on standardized imaging, ulcer segmentation, classification, and mobile detection had already built important artificial-intelligence foundations before COVID-19. The NVIDIA-sponsored Diabetic Foot Ulcer Challenge 2020 then launched its training dataset in April 2020—during the pandemic period—and brought international computer-vision teams to a common benchmark.
COVID did not initiate remote diabetic-foot imaging. It stepped on the accelerator. Foot Selfies and telemedicine became practical bridges when ordinary clinic access became difficult.
From active snapshots to ambient surveillance
The newest systems reduce the friction again. BlueDrop’s OneStep platform combines visible-light imaging with plantar temperature sensing. Its peer-reviewed 2025 feasibility study enrolled 27 people with previous ulcers; 26 had active devices and averaged about 80% adherence over 12 weeks. That pilot adds to the lineage of home imaging; it should not be mistaken for the invention of the imaging scale. Empo now contributes another full-color approach and a useful real-world usability signal.
Implementation is evolving, too. In Peru, our collaborators did not deploy a finished system nationwide. They conducted co-design and implementation research: eight workshops with 54 patients, caregivers, and health professionals in urban Lima and semi-rural Piura. The pilot is still to come. That distinction makes the work more credible, not less.
Looking back, the Foot Selfie was never really about taking pictures. It was about changing the geography of care—first by asking the patient to bring the foot to us through a phone, and now by letting the home quietly help keep watch.
The camera has changed. The workflow has changed. The mission has not: find trouble while it is still small, and help more people keep both feet firmly on the ground.
Perhaps it is finally time to tell the full history of the Foot Selfie.
Reference
Hu E, Khandelwal A, Dahlseng E, Saini N, Gretz D, Lewis J, Silverstein R, Arora N, Huynh Q, Markinson B. Usability and feasibility of an in-home full-color imaging scale for remote monitoring of high-risk patients with a history of diabetic foot ulcers: retrospective observational formative evaluation. JMIR Form Res. 2026;10:e94016. doi:10.2196/94016. PMID: 42492077.
#FootSelfie #ActAgainstAmputation #DiabeticFoot #LimbPreservation #RemoteMonitoring #ArtificialIntelligence #DigitalHealth #HealthcareInPlace
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